Cherokee Nation Pharmacy Director Jeff Sanders and Pharmacist Amy Christie point out features of the tribe’s new central pharmacy’s automation system. Located at Three Rivers Health Center in Muskogee, Okla., the system will be used to fill prescriptions for pick-up at all CN medical facilities. COURTESY PHOTO

CN to implement automated central pharmacy

BY STAFF REPORTS
04/12/2011 07:01 AM
MUSKOGEE, Okla. – Patients of the Cherokee Nation’s health system will soon enjoy faster, more efficient pharmacy services.

A new central pharmacy located at Three Rivers Health Center in Muskogee features an automation system that will fill prescriptions for pick-up at all CN medical facilities and be used for mail order prescription services.

Jeff Sanders, the tribal health system’s pharmacy director, said the central pharmacy’s automated system is efficient and capable of handling the large volume of prescriptions it’s expected to see.

“With this system, we will be able to fill 10,000 prescriptions per eight hour shift,” said Sanders. “It will open with a staff of 11 including four pharmacists, five techs and two clerks.”

Sanders said that most traditional pharmacies fill 100 to 180 prescriptions per pharmacist in a shift of eight hours. In 2010, CN pharmacies filled almost 1.25 million prescriptions.

With its conveyor belts and quality check stations, the automated system has the appearance of a manufacturer’s assembly line. The system is software driven. It sorts, measures and packages prescriptions for distribution. The pharmacy staff will oversee the operation and be on hand to assure the quality of the prescriptions the system fills.

Sanders said the transition to an automated central pharmacy will be seamless for patients and that there will be no interruption in their prescription drug supply. He also said he encourages patients to take advantage of the mail order prescription service available to them.

“We want our people to sign up for mail order prescriptions,” he said. “It cuts down on lines at the clinics, and that makes patients a lot happier.”

The new pharmacy service is scheduled to be in full use by all CN health centers by June 30.

Health

BY LENZY KREHBIEL-BURTON
Special Correspondent
07/28/2016 12:00 PM
TAHLEQUAH, Okla. – The federal government’s Indian Health Services is changing its policies regarding opioid prescription, but patients at Cherokee Nation health clinics will see little change in their pain management options. On July 6, CN citizen and IHS Principal Deputy Director Mary Smith announced that health care providers at Claremore Indian Hospital and other federally operated facilities are now required to check state Prescription Drug Monitoring Program databases prior to prescribing and dispensing opioids for pain treatment longer than seven days and periodically throughout chronic pain treatment for 90 days or more. According to the Centers for Disease Control, the rate of opioid abuse-related deaths among American Indians and Alaska Natives nationwide has increased almost four-fold, going from 1.3 for every 100,000 people in 1999 to 5.1 per 100,000 in 2013. Data collected by IHS also indicates that the rate of drug-related deaths among American Indians and Alaska Natives is almost double that of the general population. With Oklahoma ranking ninth nationally in the number of prescription drug overdose deaths, the Legislature passed a measure in 2015 requiring all physicians to check the state’s prescription database before writing a scrip for schedule II-, III-, IV- and V-controlled substances, which includes oxycodone and hydrocodone. State law also requires similar checks to be performed periodically after prescribing the medication if it is to be used for chronic pain management for more than 180 days. Doctors, pharmacists and nurse practitioners at CN health facilities have been using the database since November. “We are very cognizant of the drug problem in our communities,” CN Senior Pharmacy Director Jeff Sanders said. “Our formulary manages what we offer as options. With the high number of patients that go through our facilities…we try to limit access to certain medications while still addressing pain needs.” Although CN Health Services officials said that it is too early to tell whether the new database policy has had any effect on the rate of prescription drug abuse or overall opioid prescription among CN patients, they did point out that it has sparked more conversations between patients and health care providers. “This has facilitated many positive discussions on how they (patients) are taking their meds and in some cases, if the provider has concerns about abuse or diversion of their medication,” CN Health Executive Medical Director Dr. James Stallcup said. “This provides valuable information. It’s taken a little time to get used to using, but it has been well worth the time and investment.”
BY STACIE GUTHRIE
Reporter – @cp_sguthrie
07/25/2016 08:30 AM
TAHLEQUAH, Okla. – W.W. Hastings Hospital is informing women about the importance of early breast cancer detection. Dr. Tschantre’ E. Dorsett, the hospital’s chief of obstetrics and gynecology, said she and her staff are providing women with patient education and brochures regarding awareness. Dorsett said it’s important to receive an exam because “the majority of breast cancers in the U.S. are diagnosed from abnormal screening studies.” “The patient, who then seeks out further testing from their provider, first detects many of these abnormalities,” she said. Dorsett said age and intervals for breast exams vary depending on what government-sponsored or medical societies recommend. “This is the reason that there may be variations in the age and intervals,” she said. “The American College of Obstetricians and Gynecologists currently recommends a clinical breast examination every one to three years from age 20 to 39, and annually thereafter. Mammography starts at age 40 and continues annually, based on ACOG guidelines. These ages are given for patients who are considered low-risk.” Dorsett said early cancer detection is important because if the tumor is smaller there is a “greater chance for successful treatment.” “Also, the earlier detected there is a decreased chance of existing spread of the cancer to other parts of the body,” she said. She said approximately 225 women visit the women’s clinic at Hastings monthly to receive breast exams. Dorsett said oftentimes women themselves are able to detect breast cancer. “Approximately one half of all cases of breast cancer in women 50 years and older and more than 70 percent of cases of cancer in women younger than 50 years are detected by women themselves, frequently as incidental findings,” she said. “These findings are brought to the attention of the provider who can then order the appropriate follow-up tests and make referrals.” Dorsett said breast cancer risk-reducing strategies include weight loss for obese patients and breastfeeding for mothers. “Breastfeeding specifically becomes significant at six months and beyond,” she said. “For every 12 months of breastfeeding the risk for breast cancer is reduced by 4.3 percent. This can be from one child or added together for several children.” Dorsett said there are tips when conducting breast self-examinations. “The most important part is not the exact technique, but rather the observation of change in the breast tissue,” she said. “It is best to pick the same time of the month to preform the exam. For a woman still menstruating this should be a few days after the period ends to decrease the likelihood of swollen or tender breasts. In a postmenopausal female, the same day of the month will help the patient remember to preform the exam.” For more information, call 918-458-3100. <strong>5 Steps When Conducting Self-Exams</strong> Look at the bare breasts in the mirror with hands on hips. Notice symmetry and report dimpling of skin or inversion of nipples. Also, redness, soreness or rash over the breast. Raise the hands over the head, look for the same changes. While lying down, use the right hand to examine the left breast and the left hand to examine the right breast. Using just the fingertips, move in a vertical motion from collarbone to top of abdomen and from the armpit to the cleavage. Small circular motions should be made to insure all breast tissue is covered. Use light, medium and firm pressure. Repeat the same procedure sitting or standing. Report any abnormal findings or changes to your health care provider.
BY WILL CHAVEZ
Senior Reporter – @cp_wchavez
07/06/2016 01:00 PM
TAHLEQUAH, Okla. – The auxiliary volunteer group at W.W. Hastings Hospital is always looking for more help and is again putting out a call for volunteers. The group has nine regular volunteers down from its usual number of 12. “It would be nice to get enough people to where we didn’t have to double up so much (work two different shifts). Being upstairs is a long day. When they work upstairs from early in the morning to who knows when, that is a long day,” volunteer Colleen Ketcher said. “I really enjoy working here. It’s been 20-something years that I’ve volunteered.” Upstairs is the third floor with patient rooms and where surgeries occur. Volunteers assist with taking phone calls from family members inquiring about a person in surgery and help family members in the waiting room feel more comfortable. Volunteers also maintain a gift shop near the hospital’s pharmacy where they sell candy, snacks, jewelry and T-shirts. Money from items sold has been used to buy rocking chairs for the hospital’s nursery and cell phone charging stations for four areas in the hospital. “The patients and the staff have really enjoyed having those here,” Ketcher said of the stations. Funds raised have also been used to buy chair beds for people wishing to stay extended periods with their loved ones in a hospital room, extra large wheelchairs, a wheelchair and teddy bears for the operating room area, car seats for patients who can’t afford them for their newborns and a bassinet for babies. “We try to give every baby that leaves here a blanket,” Ketcher said. “In general, when they (staff) come and say they need something we try to donate. That’s what we’re here for, the patients, and we do our best to do whatever we can for them.” After Betty Lunsford moved to Tahlequah and began using the hospital for her medical care, she said she began thinking about volunteering to give back to the hospital. She said she volunteers at Hastings because its staff was “good to her mother” when she was dying. “She was here in ICU (Intensive Care Unit) when she passed away, and they were so good to us. And then I had a brother who passed away here, too, and they went out of their way to help us up there in ICU,” she said. “If someone has hours to give, like me, I’m alone, do I want to sit at home all the time and be lonely or had I rather be out with someone else and have the companionship and helping someone?” Phyllis Jimmeye volunteers to give back to the facility she worked at for more than 20 years. “I volunteer because I worked here for over 20 years. This is a way that I can still have contact with people that I worked with, and plus I’m able to see some of my family that I normally wouldn’t see because they use this facility,” she said. The auxiliary holds meetings at 1 p.m. every second Tuesday of the month. The meetings are open to the public and people interested in volunteering may attend. Meetings are in the conference room of the annex building in front of the playground just west of the hospital’s main entrance on the third floor. People interested in volunteering or wanting more information should call 918-458-3100, ext. 4127. “If someone really wants to get a blessing, I think this is a good place to get one because whatever you give, you’re going to get back way more,” Ketcher said. “These patients are so grateful just for a smile. When you’re sick just a smile or a greeting like ‘good morning,’ that’s something they really love.”
BY RENEE FITE
Tahlequah Daily Press
06/29/2016 08:30 AM
HULBERT, Okla. – A date to the prom with someone special is a dream shared by many girls and boys, and one that recently came true for Cherokee Nation citizen Paige Walls. The Hulbert High School senior expected her dad to be her escort to prom, but when he couldn’t get off work, another stand-in was given a written invitation with “yes” and “no” boxes to check in reply. Dr. James Lewis, a W.W. Hastings Hospital pediatrician, said he didn’t hesitate to say “Yes” to the young girl who calls him “Dr. Grandpa” while on a follow-up visit. Lewis has been the 18-year-old’s pediatrician since birth, when she was diagnosed with CDKL5, a rare neurological seizure disorder. Children with CDKL5 all have developmental delay and Paige can’t communicate. “I was blown away, very honored,” said Lewis. “I said ‘I’d love to.’ She’s part of the family. I even did a house call when she was so sick.” Paige’s mom, Mona Walls, said Lewis was the “next best thing” because he’s been in her life so long. “He loves her just like a granddaughter,” said Mona, who crafted the written invitation. “It’s probably a little old fashioned, but I wanted Paige to be able to ask him. She handed him the invitation.” Lewis read it out loud to Paige. “Mona deserves all the praise. She has taken her everywhere for help, from Houston to Memphis, and taken training in epilepsy. When Mona says ‘Jump,’ I say ‘How high?’ She’s very knowledgeable,” Lewis said. He said the invitation reminded him of his high school prom at Tulsa Edison in 1964. “She even offered to pick me up,” Lewis said, “but I live just up the street so I hopped into the little bug and met her there.” For this special occasion, a purple corsage in the school colors was given to his date and Lewis received a boutonniere when they met that evening. “It was a fun evening. I escorted her inside. We had our picture taken by an old car and lots of kids came up and said ‘Hi,’ and gave her hugs,” Lewis said. “We had a delicious meal of steak and chicken. An amateur magician was the entertainment.” Mona was also in attendance, but scooted a little away from her daughter and date at dinner so they could have “their time.” “I think she was excited. She was aware she was on a date with him,” Mona said. “While they were watching the magic show, she was holding his hand. When he let go she got a little irritated so he held her hand again. She was happy.” Gratitude is what the Walls family felt. “I was glad she was able to experience that. He made her feel very special,” Mona said. “We were honored he took her. He’s so selfless.” “Dr. Grandpa” also was greeted by many of his patients with “Hi, Dr. Lewis.” “In that 17- and 18-year-old crowd there were some Joe Cool types,” Lewis said, “and girls wearing prom dresses and gowns, and guys in cowboy hats, boots and string ties.” He saw friends and a former neighbor, Marilyn DeWoody, superintendent of Hulbert Public Schools. “I hadn’t seen her in ages,” he said. “She thanked me for taking Paige.” The two also shared a wish for special needs people because once the students reach 18 years old and graduate, there’s nothing for them, such as services during the day. “I wish the tribe would consider a respite center for the handicapped to go to during the day with recreational, physical and occupational therapy, a teacher, a great classroom, activities and other people too,” Lewis said. “There’s a bunch of vacant buildings in town for rent.” Mona agreed, saying she doesn’t know what she’ll do with her daughter now that she’s graduated. “She loves music and quality time with people and art. If someone would do it two hours a day a couple of days of week that would be great,” she said. At prom, when the magician finished, it was after 8 p.m. and they took more pictures. “A lot of people came up to her and took pictures with her,” Mona said. The dance started next, which signaled it was time to call it a night. It was Lewis’ first time to be a prom escort, although he’s attended many high school graduations. “It was sort of cool. I had a great time,” he said. <strong>– Reprinted with permission from the Tahlequah Daily Press</strong>
BY SHEILA STOGSDILL
Special Correspondent
06/28/2016 12:00 PM
TAHLEQUAH, Okla. – The Cherokee Nation is blazing a path in hepatitis C treatment with a project that is curing Cherokees infected with the disease. At the project’s center is Dr. Jorge Mera, infectious diseases director, who in October founded a hepatitis C elimination project. The CN has the first health organization in the country to start such a program, he said. “But before the elimination program we started addressing the problem in 2012 through September of 2015 with increased screenings other patient care,” Mera said. The project has screened 12,000 Cherokee patients for hepatitis C, and among those testing positive, more than 300 have been treated and are considered cured of the infection that causes liver disease, officials said. That project earned Mera the distinction of being honored in May at the White House ceremony on National Hepatitis Testing Day. “The award is a wonderful recognition from the White House to all the Cherokee Nation providers, health professionals and administration for making this program a success in changing lives and combating hepatitis C,” Mera said after the ceremony. “We have a lot of work ahead, but I think we have made the invisible epidemic, now visible.” An estimated 3.5 million people have hepatitis C, according to the U.S. Health and Human Services. According to a CN press release, the number of hepatitis C-related deaths reached an all-time high of 19,659. However, Mera said, patients are now being treated with Food and Drug Administration-approved hepatitis C virus antivirals. “The cost of a treatment varies, but a treatment may cost from $52,000 to over $100,000 depending on the combination of drugs used,” Mera said. “Of the patients who have completed treatment we have a cure rate that is around 90 percent.” The program’s protocol follows the American Association for the Study of Liver Disease and Extended Community Health Outcomes recommendations. “No patients have died while receiving antiviral drugs but several patients have died of end stage liver disease either before they received treatment or after they completed treatment,” Mera said. No hepatitis C vaccine exists, but there is ongoing research to develop one, he said. “It is the No. 1 cause of mortality of the reportable infectious diseases in the United States,” Mera said. “It causes more deaths than the other 59 diseases combined.” Mera said in the United States more that 70 percent of the infected are in the Baby Boomer Generation, people born between 1945-65. “In Cherokee Nation the patients we are detecting now have an average age of 44,” Mera said. “Around 50 percent of our patients are in the Baby Boomer age group but the other half is younger.” Within the elimination program, there are research studies regarding transmission risk factors in the CN population, Mera said. The highest risk of contracting hepatitis C is probably in people who inject drugs by sharing contaminated needles, syringes or paraphernalia used during the injection process and having unprotected sex with an infected partner, he said. Treatment of patients with substance abuse disorders is also important because this will decrease their chances of using drugs. So having behavioral health, rehab services and opioid substitution programs are also important parts of prevention. “Also, tattooing is a possible risk factor so only getting tattoos done by professionals who are licensed,” Mera said. Treatment of infected patients also is a form of prevention because once a patient is cured he or she cannot transmit the infection, he said. “Most patients are asymptomatic,” Mera said. “When symptoms appear it usually is a manifestation of advanced liver disease or liver cancer.” Screening is the key to early detection of the disease, he said. Eighty-five percent of patients will develop a chronic infection and between 20 percent and 30 percent will develop cirrhosis of the liver, he said. <strong>Facts About Hepatitis C</strong> • Hepatitis C can begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. • Hepatitis C ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It is spread primarily through contact with the blood of an infected person. About 75 percent to 80 percent of people infected with the virus develop chronic infection, a long-term illness when the virus remains in a person’s body. It can lead to serious liver problems, including cirrhosis or scarring of the liver or liver cancer.
BY ASSOCIATED PRESS
06/27/2016 04:00 PM
OKLAHOMA CITY (AP) – The Cherokee Nation has been awarded a $1 million grant as part of an effort to get more children enrolled in federal welfare programs for which they are eligible, federal officials announced on June 13. The Center for Medicare and Medicaid Services announced the Tahlequah-based tribe is one of 38 recipients from 27 states to receive part of the $32 million in awards that are called Connecting Kids to Coverage grants. The money is aimed at enrolling eligible children in Medicaid and the Children’s Health Insurance Program, or CHIP, which is another program that provides health coverage to children. “Unfortunately, the Cherokee Nation has 22 percent of their (eligible) kids who have not signed up,” Principal Chief Bill John Baker said. “This million-dollar grant gives us the opportunity to do more outreach, to get in the communities, to PTA meetings, school functions, maybe even some billboard advertising, things like that to educate and make more of our citizens aware that this health care is available to the kids. Baker said because CN citizens who live within the tribe’s boundaries already receive free health care at tribal clinics, they may not be aware that they also qualify for federal programs like Medicaid. The CN was the only Oklahoma recipient in the latest round of awards, which specifically target vulnerable populations, including teenagers, children in rural communities and Hispanic and American Indian children, said Victoria Wachino, director of CMS’ Center for Medicaid and CHIP Services. “Today’s announcement means more children will have access to coverage early in their lives which will help them grow into healthy adults, succeed in school and reduce financial burdens on their families,” Wachino said. Figures released on June 13 by CMS show more than 710,000 Oklahoma children enrolled in Medicaid and CHIP programs in 2015, an increase of nearly 2 percent from 2014, but still below the national average of 2.5 percent. “Since the passage of the Affordable Care Act, the rate of uninsurance for children has declined to its lowest levels on record,” U.S. Secretary of Health and Human Services said. “Fewer than 1 in 20 children are now uninsured.”